ABSTRACT
A 53-year-old man was referred to our hospital due to a mediastinal mass found during a medical checkup in July 2009. He had a past history of hyperparathyroidism, for which he underwent surgery in 1994, and also had a family history in that his sister had multiple endocrine neoplasia type 1 (MEN1). He was given a diagnosis of MEN I on genetic testing. Chest CT revealed a mediastinal mass 4 cm in maximum dimension, and an atypical carcinoid was diagnosed according to mediastinal biopsy findings. Bone metastasis was detected and he was given cisplatin and etoposide. The tumor decreased in size by 30%, and was evaluated as showing partial response. Although there are some cases of MEN-related thymoma treated by surgery, a case which successfully responded to chemotherapy alone is thought to be extremely rare.
Subject(s)
Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Carcinoid Tumor/complications , Carcinoid Tumor/drug therapy , Multiple Endocrine Neoplasia Type 1/complications , Thymus Neoplasms/complications , Thymus Neoplasms/drug therapy , Carcinoid Tumor/diagnosis , Cisplatin/administration & dosage , Etoposide/administration & dosage , Humans , Male , Middle Aged , Multiple Endocrine Neoplasia Type 1/diagnosis , Multiple Endocrine Neoplasia Type 1/genetics , Thymus Neoplasms/diagnosis , Treatment OutcomeABSTRACT
We report a case of drug-induced pneumonia associated with the herbal medine Syakuyakukanzo-to. A 82-year-old man was admitted to our hospital complaining of cough, fever, and dyspnea after administration of shakuyakukanzoto for two weeks. Drug-induced lymphocyte stimulation tests were negative, but bronchoalveolar lavage showed an increase in lymphocytes with an increased CD4/CD8 ratio. Cessation of the drug improved the patient's clinical and X-ray findings and then he was able to be discharged. He was admitted again for a challenge test. His clinical symptoms and X-ray findings became worse 8 days after re-administration, therefore we diagnosed drug-induced pneumonia caused by Shakuyakukanzoto. He has had no recurrence after discontinuance of the drug. To the best of our knowledge, there has been no previous case of drug-induced pneumonia due to Shakuyakukanzo-to reported in the world.
Subject(s)
Anti-Inflammatory Agents, Non-Steroidal/adverse effects , Bronchial Provocation Tests , CD4-CD8 Ratio , Drugs, Chinese Herbal/adverse effects , Pneumonia/chemically induced , Pneumonia/diagnosis , Aged, 80 and over , Bronchoalveolar Lavage Fluid/cytology , Bronchoalveolar Lavage Fluid/immunology , Diagnosis, Differential , Drug Combinations , Glycyrrhiza , Humans , Male , Paeonia , Time FactorsABSTRACT
A 31-year-old woman in whom primary pulmonary hypertension had been diagnosed at age 18, was admitted because of dyspnea on exertion and for evaluation of pregnancy risk. The perfusion scanning was not diagnostic, but chest CT suggested stenosis of pulmonary arteries instead of primary pulmonary hypertension. Echocardiograms and cardiac catheterization revealed pulmonary hypertension of pulmonary arterial pressure 71/13 (mean 39) mmHg with no cardiac defects. Selective pulmonary angiograms showed multiple stenosis of pulmonary arteries with poststenotic dilatations. We diagnosed multiple peripheral pulmonary artery branch stenosis with the pulmonary hypertension because systemic vasculitis was excluded because there were no signs of inflammation or any systemic arterial invlolvement This case was thought to be congenital, considering her history of over 30 years. In reports from western countries, maternal rubella and familial factors were important etiologic factors of this disease. Few cases have been reported in Japan and all cases, including the present case, were unrelated to the specific etiological factors. We recommended her to use birth control and have been observing her very carefully since the progression of the pulmonary hypertension is the major determinant of her prognosis.
